NPIMap

Organization Active NPI

Medical Network of Alaska, LLC

Doing business as Alaska Advanced Dermatology

  • Dermatology Physician
  • Anchorage, AK
National Provider Identifier
1235024936
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MEDICAL NETWORK OF ALASKA, LLC
Doing business as
Alaska Advanced Dermatology
Practice address
1100 E Dimond Blvd
Anchorage, AK 99515-2001
Phone
(907) 357-2332
NPI assigned
Jun 11, 2025
Organization subpart
Yes
Parent organization
MEDICAL NETWORK OF ALASKA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacquelyn Renee Blomker
Title
Revenue Cycle Manager
Phone
(907) 357-9590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1100 E Dimond Blvd
Anchorage, AK 99515-2001

Mailing address

3331 E Meridian Park Loop
Wasilla, AK 99654-7294

Other names 1

  • Alaska Advanced Dermatology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Capstone Family Medical9 organizations share this tax ID, including this one
Part of
Capstone Family Medical

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1235024936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3331 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E DIMOND BLVD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995152001",
            "telephone_number": "907-357-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL NETWORK OF ALASKA, LLC",
        "enumeration_date": "2025-06-11",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "BLOMKER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "907-357-9590"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alaska Advanced Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.